Predictive value of response to steroid therapy on response to splenectomy in children with immune thrombocytopenic purpura

BackgroundMany but not all studies suggest that a favorable response to preoperative steroid therapy predicts a successful outcome after splenectomy in children with immune thrombocytopenic purpura (ITP). The purpose of this study is to further examine the relationship between steroid response and outcome after splenectomy in children.MethodsAfter institutional review board approval, records of children undergoing splenectomy for ITP were reviewed. Patients’ responses were determined by platelet counts and grouped by complete response (CR; ≥150,000/μL), partial response (PR; 149,999– ≥50,000/μL), or no response (NR; <50,000/μL).ResultsThirty-seven children were identified. After steroid therapy, 20 patients (54%) had CR, 9 (24%) had PR, and 8 (22%) had NR. After splenectomy, 31 patients (84%) had CR, 6 (16%) had PR, and 0 had NR. Of the 20 patients that had a CR to steroid therapy, 18 (80%) had CR and 2 (20%) had PR to splenectomy. Of the 9 patients that had PR to steroids, 7 (78%) had CR to splenectomy and 2 (22%) had PR. Of the 8 patients that had NR to steroids, 6 (75%) had CR and 2 (25%) had PR to splenectomy. Response to splenectomy was not associated with response to steroids (P = .59).ConclusionThese data suggest that response to splenectomy in children with ITP is unrelated to previous response to steroids.